Low Socioeconomic Areas Research Articles

Financial toxicity of childhood cancer and changes to parents' employment after treatment completion.

Childhood cancer can have short- and long-term impacts on parents' finances and employment. It is important to understand how families adjust to the financial and employment changes caused by childhood cancer, the ongoing impacts after treatment completion, and which families need more targeted support. Qualitative research is necessary to facilitate an in-depth understanding of the employment and financial impacts on families and to capture parents' complex and nuanced experiences and perspectives. We interviewed 56 parents of childhood cancer survivors (M=2.13 years after treatment completion; 89% mothers) using the vocational and financial impact section of the Psychosocial Adjustment to Illness Scale-Carer Interview Form. We analyzed interviews using content analysis. Parents reported multiple sources of financial toxicity including travel to and from the hospital and needing to reduce their working hours during their child's cancer treatment. Workplace flexibility was an important factor to protect against unwanted vocational changes. After treatment completion, families living in low socioeconomic areas commonly reported ongoing financial difficulties. Mothers, particularly those who were on maternity leave when their child was diagnosed with cancer, reported ongoing employment impacts including unemployment. Clinical staff including social workers could more consistently assess families' financial distress and refer to professional services who can offer guidance for financial decision-making as standard care. Flexible workplace agreements appear important for parents of children with cancer. Our findings can assist organizations to understand that cancer-related disruptions are likely to continue after treatment completion, and therefore should offer benefits to parents where possible.

Weight Change and Its Association with Cardiometabolic Risk Markers in Overweight and Obese Women.

Objectives To examine the association of weight loss magnitude with changes in cardiometabolic risk markers in overweight and obese women from low socioeconomic areas engaged in a lifestyle intervention. Methods Analyses were performed on 243 women (mean body mass index 31.27 ± 4.14 kg/m2) who completed a 12-month lifestyle intervention in low socioeconomic communities in Klang Valley, Malaysia. Analysis of covariance (ANCOVA) was used to compare changes of cardiometabolic risk factors across weight change categories (2% gain, ±2% maintain, >2 to <5% loss, and 5 to 20% loss) within intervention and control group. Results A graded association for changes in waist circumference, fasting insulin, and total cholesterol (p=0.002, for all variables) across the weight change categories were observed within the intervention group at six months postintervention. Participants who lost 5 to 20% of weight had the greatest improvements in those risk markers (−5.67 cm CI: −7.98 to −3.36, −4.27 μU/mL CI: −7.35, −1.19, and −0.59 mmol/L CI: −.99, −0.19, respectively) compared to those who did not. Those who lost >2% to <5% weight reduced more waist circumference (−4.24 cm CI: −5.44 to −3.04) and fasting insulin (−0.36 μU/mL CI: −1.95 to 1.24) than those who maintained or gained weight. No significant association was detected in changes of risk markers across the weight change categories within the control group except for waist circumference and adiponectin. Conclusion Weight loss of >2 to <5% obtained through lifestyle intervention may represent a reasonable initial weight loss target for women in the low socioeconomic community as it led to improvements in selected risk markers, particularly of diabetes risk.

Primary care provision for mental health

The treatment of mental illness in New Zealand has seen a steady transition from institutionalised to community-based care, from the mental institutions of the late 19th century to the service-based facilities we see today. While this change in attitude towards mental illness is to be celebrated, it does not come without its challenges, and general practice (GP) clinics nationally have been finding these hard to overcome, particularly in rural and low socio-economic areas. But these challenges are not insurmountable, and, as a body, we welcome more opportunities to reduce the escalation of common mental health problems to a scale that requires hospital or specialist residential care.

Exploring children’s participation in commercial swimming lessons through the social determinants of health

Drowning is a public health challenge, disproportionately impacting children. Social determinants of health (SDH) such as socio-economic disadvantage and geographic isolation increase drowning risk. Swimming and water safety lessons, in part, have reduced drowning in children, while also enabling healthy aquatic participation. Research suggests that some Australian children receive insufficient swimming and water safety education and are not achieving essential skills. A cross-sectional retrospective analysis of swimming and water safety skills achieved by a cohort of children (5-12years) attending commercial swimming lessons in three Australian states was undertaken. Variables included participant demographics (age, gender, and the SDH of socio-economic status [SES], and geographical remoteness) and skills being taught and achieved. Skills achieved were analysed against the National Swimming & Water Safety Framework and the National Benchmark. Swim schools were more likely to teach freestyle (87%) and backstroke (83%); and less likely to teach water safety skills like treading water (53%), and survival backstroke (46%). Overall, 40% of 12-year-old children failed to achieve the National Benchmark of 50 metres freestyle, fewer were achieving minimum water safety skills. Children from low socio-economic areas and regional locations were less likely to be achieving 50 metres freestyle. Children in this study were commonly from major cities (94%) and of high socio-economic areas (53%). Swimming lessons must incorporate a broad range of swimming and water safety competencies to ensure children have the skills required to reduce drowning, especially for those deemed at increased risk. Stakeholders must prioritise holistic drowning prevention education strategies, ensuring all children can access swimming and water safety programs regardless of their socio-economic status or geographical location.

Protocol for a mixed methods process evaluation of a hybrid implementation-effectiveness trial of a scaled-up whole-school physical activity program for adolescents: Physical Activity 4 Everyone (PA4E1)

BackgroundPhysical Activity 4 Everyone (PA4E1) is a physical activity program for secondary schools located in low-socioeconomic areas. Over a 24-month period, schools in the program arm of a cluster randomised controlled trial (n = up to 38 schools) will receive a multi-component implementation support strategy to embed the seven school physical activity practices of the PA4E1 program. This article describes the process evaluation of the PA4E1 hybrid implementation-effectiveness trial. The process evaluation aims to describe the fidelity and reach of the implementation support strategies using quantitative data; and to describe the acceptability, appropriateness and feasibility of the implementation support strategies and physical activity practices to school stakeholders using mixed methods.MethodsQuantitative and qualitative data will be collected from participants (Physical Education teachers, in-School Champions, students) in the program arm. Data collection will involve semi-structured interviews, focus groups, a fidelity monitoring log, a fidelity checklist, surveys, and routinely collected administrative and website data. Quantitative data will be analysed descriptively and qualitative data will be analysed thematically within and across data sets. Triangulation between data sources will be used to synthesise findings regarding the implementation and potential mechanisms of impact of PA4E1 on school physical activity practice adoption, with respect to context.DiscussionResults of the process evaluation will facilitate the interpretation of the findings of the trial outcomes. It will comprehensively describe what was actually implemented and identify the potential contribution of the various components of the implementation support strategy to the school physical activity practice adoption outcomes. Findings will inform future improvement and scale-up of PA4E1 and approaches to implementing secondary school-based physical activity programs more broadly.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12617000681358 registered 12 May 2017.

Factors associated with frequent consumption of fast food among Australian secondary school students.

To examine demographic and behavioural correlates of frequent consumption of fast food among Australian secondary school students and explore the associations between fast food consumption and social/environmental factors. Cross-sectional survey using a web-based self-report questionnaire. Secondary schools across all Australian states and territories. Students aged 12-17 years participating in the 2012-2013 National Secondary Students' Diet and Activity survey (n 8392). Overall, 38 % of students surveyed reported consuming fast food at least weekly. Being male, residing in lower socio-economic areas and metropolitan locations, having more weekly spending money and working at a fast food outlet were all independently associated with consuming fast food once a week or more, as were several unhealthy eating (low vegetable intake and high sugary drink and snack food intake) and leisure (low physical activity and higher commercial television viewing) behaviours and short sleep duration. Frequent fast food consumption and measured weight status were unrelated. Students who agreed they go to fast food outlets with their family and friends were more likely to report consuming fast food at least weekly, as were those who usually 'upsize' their fast food meals and believe fast food is good value for money. These results suggest that frequent fast food consumption clusters with other unhealthy behaviours. Policy and educational interventions that reach identified at-risk groups are needed to reduce adolescent fast food consumption at the population level. Policies placing restrictions on the portion sizes of fast food may also help adolescents limit their intake.

The illicit cigarette market in six South African townships

BackgroundWe estimate the size of the illicit cigarette market in low socioeconomic areas in South Africa before and after a tax increase. In 2018, the real excise tax increased by...

Association between Selected Food Purchase Practices, Physical Activity and Sociodemographic Factors among People Living in a Low Socioeconomic Peri-Urban and Rural Area of South Africa

Introduction: This study examined the association between sociodemographic factors, Physical Activity (PA) engagement, and the selected Food Purchasing Practices (FPP) among people living in a low socioeconomic peri-urban and rural area of two provinces of South Africa. Methodology: Four hundred participants were randomly selected from two communities, a township in Cape Town and a rural community in the Eastern Cape where the Prospective Urban and Rural Epidemiological (PURE) study was implemented. Data collected included socio-demographic characteristics, FPP and PA. Logistic regressions were performed to identify the associations between sociodemographic factors, PA involvement and selected FPP, and Odds Ratios (OR) were calculated with 95% Confidence Intervals (CIs). All statistical tests were two-tailed at p&lt;0.05. Results: A large percent, 76.3% were females and 23.8% were males. Compared to participants aged ≥55 years, those within the age range of 25-54 years were more likely to travel with motorised transport (OR= 4.7; 95% CI=2.6, 8.3; p &lt; 0.001) compared to walking to grocery shop. None-to-low education and with monthly income of &lt;R2000 were more likely to purchase groceries at the supermarkets (OR= 2.7; 95% CI=1.4, 5.0; p &lt; 0.05) and (OR= 2.4; 95% CI=1.1, 5.1; p &lt; 0.05) compared to spaza or small informal food shop, respectively, while those who engage in PA were less likely to purchase groceries at the supermarkets (OR= 0.36; 95% CI=0.2, 0.8; p &lt; 0.05). Conclusion: Some demographic factors and PA have an influence on FPP among people living in a low socioeconomic peri-urban and rural area of two provinces of South Africa. This might be an area to be focused on for public health interventions which could be directed at supporting adequate FPP among people, especially in low socio-economic areas.

Effect of mammography screening and sociodemographic factors on stage of female breast cancer at diagnosis in New South Wales

Objective The aims of this study were to assess the effects of screening through BreastScreen NSW on the stage of cancer at diagnosis, and differences in cancer stage at diagnosis according to sociodemographic factors. Methods Using linked BreastScreen NSW screening attendance records and NSW Cancer Registry data, the effects of screening participation and sociodemographic characteristics on stage at diagnosis were investigated using Kruskal-Wallis analysis of variance or the Mann-Whitney U-test for the 2002-13 diagnostic period. Multivariate logistic regression was used to investigate predictors of stage at diagnosis. Results The association between BreastScreen NSW participation and earlier stage at diagnosis was strongest when the last screening episode occurred within 24 months of the cancer diagnosis, with an odds ratio of localised versus non-localised cancer of 1.61 (95% confidence interval 1.51-1.72). Women aged ≥70 years, Aboriginal women, residents of major cities and women living in areas of socioeconomic disadvantage were more likely to have distant than non-distant stage at diagnosis. A trend towards more distant stage in more recent diagnostic years was evident after adjusting for screening participation. Conclusions The strongest and most consistent predictor of earlier stage at diagnosis was BreastScreen NSW participation. Continued efforts to increase screening participation are important to achieve earlier stage at diagnosis, particularly for sociodemographic groups with more advanced disease. What is known about the topic? Earlier cancer stage at diagnosis is a prerequisite for mortality reduction from screening. Past research indicated that screening participation in New South Wales (NSW) was strongly associated with early stage at diagnosis and mortality reduction. More contemporary data are needed to monitor screening performance in NSW and assess differences in cancer stage across sociodemographic subgroups. What does this paper add? Using data linkage, this paper indicates associations between screening, sociodemographic factors and stage at diagnosis for the NSW population in 2002-13. Contrary to expectations, major city residents tended to have a lower proportion of early stage breast cancer at diagnosis, which may be indicative of lower screening coverage and barriers to screening. Compared with past research, similar effects of screening and other sociodemographic factors on the stage of breast cancer at diagnosis were observed. This paper compares screening histories across sociodemographic groups, indicating statistically significant differences. What are the implications for practitioners? Increasing screening participation is particularly important for sociodemographic groups who are diagnosed at more advanced stages, including women from lower socioeconomic areas, Aboriginal and Torres Strait Islander women and residents of major cities. In particular, the results reinforce the need to further develop targeted strategies to increase screening participation among NSW women from lower socioeconomic areas and Aboriginal and Torres Strait Islander women. Further investigation into screening coverage and barriers to screening for residents in major cities is needed.

Strongyloidiasis associated with duodenal dysplastic changes: a case report

Strongyloides stercoralis is an intestinal nematode that infects the mankind worldwide, particularly in low socioeconomic status areas. It has a unique autoinfection phenomenon, which enables it to reproduce permanently even after cessation of exposure. Strongyloidiasis is an easily missed disease and is fatal usually when the immunity is suppressed due to disseminated infection and consequent multiorgan damage. The authors present a case of strongyloidiasis associated with duodenal mucosal dysplasia beyond the usual reactive changes. S. stercoralis is a treatable infection and should be cared for properly. Pathologists have a major role in its detection. Mucosal changes are not usually reactive and should not be overlooked.

The Effects of Blended Learning on STEM Achievement of Elementary School Students

Science, technology, engineering, and mathematics (STEM) programs serving students from low socioeconomic areas are understudied in the literature. More research studies need to be conducted to make informed instructional decisions for students who may be at a disadvantage compared to their peers from higher socioeconomic areas. The purpose of this research study was to determine the effects of traditional science instruction and blended learning on STEM achievement of elementary school students from low socioeconomic areas. Third, fourth and fifth grade students (N = 129) from a low-socioeconomic school were randomly assigned to receive traditional science instruction or a blended learning science curriculum approach. The science, technology, engineering, and mathematics (STEM) achievement scores were analyzed by conducting a one-way two-group Multiple Analysis of Variance (MANOVA) implemented in R statistical computing platform (R Core Team, 2018). The results indicated that the teaching method had a statistically significant effect on the linear combination of the science, technology, mathematics and engineering scores (F(4,124) = 80.27, p &lt; .0001, Pillai’s Trace = .721, partial η2 = .721), in favor of the blended learning approach.

The effect of linguistic comprehension instruction on generalized language and reading comprehension skills: A systematic review.

The effect of linguistic comprehension instruction on generalized language and reading comprehension skills: A systematic review.

Learners’ and Educators’ Perceptions of Gang Involvement in Western Cape

The aim of this article is to discuss the dynamics of gang involvement by considering the social reproduction perspective and resistance theory literature and by examining general perceptions of learners and adults who regularly experience gang violence. In a study utilising quantitative and qualitative design, a questionnaire was administered to 360 Grade 6 learners in low socio-economic areas in Western Cape, South Africa. Interviews with educators and two experts in the field of gang involvement were conducted. In contrast with the current trend in literature, the participants made no distinction between gangs as marginalised individuals and gangs as deviant subcultures. This may be ascribed to the current high prevalence of violence which is associated with gangs in Western Cape. It was found that, while learners express their fear of gangs, some identify with and idealise gang life.

Implementing HEM in the assessment of oral health promotion to families in underserved areas

Abstract The aim was to, in an oral health promoting setting in low socioeconomic areas, implement a method aiming at improving quality of work by assessing both formative and summative results. The overall aim is to decrease health inequity. Methods Five teams of dental hygienists (n = 5) and dental nurses (n = 3), who operated in socioeconomic low-status areas, participated. The teams were performing health promoting activities on arenas as for example family-centrals. These teams were introduced on how to report health promoting activities according to the Health Equilibrium Methodology (HEM), which is based on Social Cognitive Theory. Following questions were put and answered in every report: Which health determinants were targeted? Did any person seem to perceive him-/herself excluded? Did anything unexpected happen? What to think about next time? Quantitative data were also documented: Almost six-hundred individuals were included in a total of 36 reports. Of these 50% were adults/parents and the rest children, most of them between 1-6 years old. The reports were written directly into a database after every activity and then processed by a facilitator and later discussed with the teams in workshops every third month. Results Analysis of the reports shows that the implementation of health promoting activities according to HEM included the following: -Identification of important health determinants. - Attention on how to get everyone involved and if anything unexpected happened. - Suggestions for change for the next time. Throughout the workshops the team-members exchanged experiences. Conclusions The HEM-method facilitates depicting and discussing the process of health promotion with focus on health equity. Thereby the method has a potential to support development of high-quality health-promoting activities in populations with low socioeconomic status. It may also lead to a better professional self-confidence.

Effect of single follow-up home visit on readmission in a group of frail elderly patients \u2013 a Danish randomized clinical trial

BackgroundUnplanned hospital admissions are costly and prevention of these has been a focus for research for decades. With this study we aimed to determine whether discharge planning including a single follow-up home visit reduces readmission rate. The intervention is not representing a new method but contributes to the evidence concerning intensity of the intervention in this patient group.MethodsThis study was a centrally randomized single-center controlled trial comparing intervention to usual care with investigator-blinded outcome assessment. Patients above the age of 65 were discharged from a single Danish hospital during 2013–2014 serving a rural and low socioeconomic area. For intervention patients study and department nurses reviewed discharge planning the day before discharge. On the day of discharge, study nurses accompanied the patient to their home, where they met with the municipal nurse. Together with the patient they reviewed cognitive skills, medicine, nutrition, mobility, functional status, and future appointments in the health care sector and intervened if appropriate.Readmission at any hospital in Denmark within 8, 30, and 180 days after discharge is reported. Secondary outcomes were time to first readmission, number of readmissions, length of stay, and readmission with Ambulatory Care Sensitive Conditions, visits to general practitioners, municipal services, and mortality.ResultsOne thousand forty-nine patients aged > 65 years discharged from medical, geriatric, emergency, surgical or orthopedic departments met inclusion criteria characteristic of frailty, e.g. low functional status, need of more personal help and multiple medications. Among 945 eligible patients, 544 were randomized. Seven patients died before discharge. 56% in the intervention group and 54% in the control group were readmitted (p = 0.71) and 23% from the intervention group and 22% from the control group died within 180 days. There were no significant differences between intervention and control groups concerning other secondary outcomes.ConclusionsThere was no effect of a single follow-up home visit on readmission in a group of frail elderly patients discharged from hospital.Trial registrationhttps://clinicaltrials.gov (identifier NCT02318680), retrospectively registered December 11, 2014.

From Mussels Stand to Becoming a Doctor: A Discussion on the Importance of Education in the Vertical Transition Between Social Strata in Terms of Career Choices and Sources of Vocational Awareness in Children with Low Socioeconomic Level

This study aims to discuss the importance of education in vertical transition between social strata in the context of career choices and vocational awareness sources in children with low socioeconomic level. The study used a phenomenological design within a qualitative research approach framework. The study group consisted of 55 fourth-grade students enrolled in a primary school in a low socioeconomic area of Izmir province in Turkey. Findings of the research laid out that the students mostly wanted to be a doctor, their positive attitudes towards the profession and their desire to be beneficial to the society gained importance in their career choices, taking the example of people who they encountered in real life and who they watched on TV affected their career choices, and that there were participant views indicating that a thorough presentation of careers was not conducted even though a number of professions were mentioned in the lesson. The findings were discussed in terms of carrying out vocational guidance more carefully for participants consisting of children with low socioeconomic level who have parents with low education level so that its disadvantages can be eliminated.

Evaluation of costs and outcomes of physician-owned hospitals across common surgical procedures

IntroductionThe Affordable Care Act introduced restrictions on the creation of new physician-owned hospitals (POH). We sought to define whether POH status was associated with differences in care. MethodsPatients undergoing one of ten surgical procedures were identified using Medicare Standard Analytic Files. Patient and hospital-level characteristics and outcomes between POH and non-POH were compared. ResultsAmong 1,255,442 patients identified, 14,560 (1.2%) were treated at POH. A majority of POHs were in urban areas (n = 30, 90.9%) and none were in low socioeconomic status areas. Patients at POH were slightly younger (POH:72, IQR:68–77 vs. non-POH:73, IQR:69–79) and healthier (CCI; POH:2; IQR: 1–3 vs. non-POH: 3; IQR: 1–4). Patients at non-POH had higher odds of postoperative complications (OR:1.67, 95%CI:1.55–1.80) and slightly higher medical expenditures (POH:$11,347, IQR:$11,139-$11,936 vs. non-POH:$13,389, IQR:$11,381–$19,592). ConclusionsPOH were more likely to be located in socioeconomic advantaged areas, treat healthier patients and have lower associated expenditures.

Results of a survey of cancer patients' willingness to travel to participate in a clinical trial.

Only 2-3% of cancer patients enrol in a trial. We surveyed patients' willingness to change clinician or treating centre, or to travel, to participate in trials, to improve trial recruitment. Of 188 respondents, 79% were willing to participate in a trial in at least one scenario. Increasing travel time, change in oncologist, private health insurance and out of pocket expenses decreased likelihood of joining a trial. Rural and regional patients, and those from lower socio-economic areas, were more willing to travel. To optimise access to trials, clinicians should refer within and between institutions.

Distributions of mass concentrations and metal compositions of fine and ultrafine particles in lower socio-economic areas in a metropolitan city of Korea

TPS 642: Environmental justice and impacts, Exhibition Hall, Ground floor, August 26, 2019, 3:00 PM - 4:30 PM Background: Socio-economic status (SES) would be a major risk factor of pollutant exposure. This study was conducted to reveal different concentrations and patterns of fine and ultrafine particle exposure in lower SES areas. Methods: Study was performed from August 2015 to July 2016 in three lower SES areas, A (heavily industrialized area), B (port area), C (beach area), in a metropolitan city (Busan) Korea. Mini Volume Air Sampler with 47 mm QMA Filter of flow rate of 5.0 L/min were used to sample PM10 and PM2.5 for 24 hours in three roof tops in centers of those areas during a weekday and weekend of each month. ICP/OES and ICP/MS were used to check 8 elements and 14 metals. Results: Average mass concentrations of PM10 and PM2.5 of area A were highest of 53.1 μg/m3 and 36.4 μg/m3, which excesed Korean annual limit (PM10 50 μg/m3, PM2.5 25 μg/m3). Those of area C were lowest (PM10 (37.9 μg/m3), PM2.5 (22.1 μg/m3)). Mass concentrations of PM10 and PM2.5 of spring exceeded 1.16 times and 1.26 times of Korean limits. Artificial origin elements (Cd, Cr, Cu, Mn, Ni, Pb, Zn) of PM10 and PM2.5 were highest in area A. Annual average contribution rate of soil was 13.9%. Regional and seasonal contribution rate of soil of PM2.5 were different with PM10. Elements with over 100 of enrichment factor were S, Cd, Pb, Mo, As, Zn, Cu, Cr, V, Ni in order (higher PM2.5 than PM10). Elements such as As, Cd, Na, S, V were higher in area B. Conclusions: Fine and ultrafine particle concentrations in three different area showed different patterns according to exposure source and season. This might be contributed by atmospheric difference such as wind speed and direction, which causes different effects of artificial origin from neighbor or remote area.

Factors Associated with Preventable Emergency Department Visits for Nontraumatic Dental Conditions in the U.S.

This study was designed to examine national trends and evaluate social determinants of health that were associated with the provision of dental services in emergency rooms in the United States between 2007 and 2014. A pooled cross-sectional database of emergency department (ED) visits combined the 2007–2014 waves of the Nationwide Emergency Department Sample. A total of 3,761,958 ED visits with dental conditions were extracted and the principal diagnosis was identified. A series of modified Poisson regression models were used to assess the relationship between patient sociodemographic factors and hospital characteristics, and the likelihood of visiting the ED for a nontraumatic dental reason. Unadjusted descriptive results indicated that there was no apparent increase in the percentage of patients who visited an ED with nontraumatic dental conditions (NTDCs) between 2007 and 2014. The greatest users of EDs for NTDCs were among those who were uninsured and Medicaid beneficiaries relative to persons privately insured. ED visitors were more likely to reside in lower socioeconomic areas (when compared with visitors in the top quartile of the income distribution). Patients in all other age groups were more likely to seek care in an ED for NTDCs relative to those 65 years of age or older. Multiple strategies are required to reduce the use of EDs for routine dental care. This approach will require an interprofessional dialogue and solutions that reduce barriers to receiving dental care.